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PedsCrit

PARDS--Beyond the Basics Part 2 with Dr. Nadir Yehya: Conventional Mechanical Ventilation

Jan 9, 2023
Dr. Nadir Yehya, Assistant Professor of Anesthesiology and Critical Care and Pediatrics, discusses selecting initial PEEP and measuring variables for optimal PEEP. The chapter explores different strategies for setting PEEP in pediatric and adult patients. It also discusses the measurement of plateau pressure in pediatric mechanical ventilation and the use of esophageal pressure monitors to titrate ventilation support. Additionally, it explores how sedation levels can affect thoracic pressure in intubated patients.
39:50

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Podcast summary created with Snipd AI

Quick takeaways

  • The podcast discusses two different strategies for setting PEEP in intubated patients with ARDS: an escalating PEEP trial and a decelerating PEEP trial.
  • Plateau pressure is a commonly used metric for guiding ventilation strategies in ARDS, while the clinical significance of driving pressure, mechanical energy, and mechanical power as therapeutic targets remains uncertain.

Deep dives

Setting PEEP in Different Ways

In setting PEEP for intubated patients with ARDS, the podcast discusses two different strategies: an escalating PEEP trial and a decelerating PEEP trial. The escalating PEEP trial involves starting with an initial PEEP based on the patient's condition and adjusting it based on the inability to decrease FiO2 to 60% or less. The PEEP is gradually increased until oxygenation improves. On the other hand, the decelerating PEEP trial starts with a higher PEEP, recruits as much as possible, and then rapidly decreases the PEEP while assessing the improvement in oxygenation. These strategies are used depending on the patient's hemodynamic stability and the presence of recruitable lung. Both strategies have their advantages, including safety and potentially faster recruitment, but they require close monitoring of inspiratory and expiratory flows to ensure accurate pressure and volume delivery.

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